Hot Topics – 4/16/2015

FRAUD/ABUSE

1. Long Term Care Rehab Therapy – A federal District Court Judge dismissed a False Claims Act Whistleblower lawsuit against a Georgia nursing home alleging that the nursing home and its rehab therapy provider billed Medicare for services that were medically unnecessary and excessive. The Court agreed that the correct standard to prove that therapy provided in a skilled nursing facility under Medicare Part A was medically unnecessary is whether those services could not be expected to result in “material improvement”. The Court also dismissed the case because the Complainant/Government “had only unsubstantiated allegations of medically unnecessary care, and not allegations of specific false claims or those showing business practices likely to result in false claim submissions.”